RU2214839C2 - Method for treating the cases of disseminated sclerosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out extracorporal treatment of patient autolymphocytes in the amount of 400-1000 cells/ml by applying an immunomodulator like glutoxime at 24-26 C during 1 h and intravenously infusing them. The procedures are repeated thrice with 72 h long pauses. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to neurology, and can be used as a treatment for multiple sclerosis (PC).

 A known method of treating PC using glucocorticosteroids is prednisolone, methylprednisolone, dexamethasone, betamethasone (Goodin D.S., 1991, Zavalishin I.A., 1991, 1996).

 There is a method of treating PC with the use of cytostatics - azathioprine, cyclophosphamide, cyclosporin A (Yudkin P.L. et al., 1991, Mackin G.A. et al., 1993).

 A known method of treating PC using cytokines - roferon, reaferon (prototype), betaferon (Fernandez O. et al., 1995).

 The disadvantage of the prototype method is the undesirable effects of the introduction of cytokines - flu-like reactions, hyperthermic syndrome, with intramuscular administration - the possibility of muscle necrosis. The possibility of developing blocking antibodies to cytokines administered intravenously or intramuscularly and a subsequent decrease in the effectiveness of therapy. The complete lack of elimination effect.

 The technical result of the proposed method is to increase the effectiveness of treatment by selective extracorporeal effects on the immune system, namely on autolymphocytes by the immunomodulator glutoxim.

This goal is achieved by using lymphocytopheresis on a blood cell separator AS-TEC 204 from Fresenius. The resulting autolymphocytes at a concentration of 400-1000 cells / ml are exposed for 1 h with glutoxim at a temperature of 24-26 ^o C, after which the autolymphocytes are returned to the patient by intravenous infusion. This procedure is repeated three times with an interval of 48-72 hours.

The advantages of the proposed solutions:
- allocation of the exact number of autolymphocytes, cells occupying one of the central places in the pathogenesis of the disease;
- targeted action of an immunomodulator on autolymphocytes in extracorporeal conditions;
- the possibility of elimination from the body of a certain amount of autolymphocytes;
- the ability to simultaneously carry out extracorporeal detoxification - elimination of plasma, and with it some of the products of autoimmune reactions (including circulating immune complexes).

Assessment of treatment results was carried out according to the following algorithm:
- registration of neurological symptoms;
- immunological examination of patients.

The following studies were carried out:
- determination of the dynamics of neurological status on the scale for assessing the severity of the condition of patients according to J. Kurtzke (1981, 1983): Disability Status Scale (DSS), Expanded Disability Status Scale (EDSS) in connection with the scale of functional systems (Functional System, FS). Additions and modifications made by HIWeiner and GW Ellison (1983) and the authors of the MRD manual (Minimal Record of Disability for Multiply Sclerosis, 1985) are taken into account. The assessment was made before and after the course of treatment;
- a study of the general immune status, which showed the state of cellular and humoral immunity and included the determination of the total and relative number of lymphocytes and their subpopulations: T-lymphocytes, T-helpers, T-suppressors, T-killers, B-lymphocytes, level of immunoglobulins G , M, A, circulating immune complexes, a composite indicator - the immunoregulatory index (IRI). This examination was carried out upon admission to the clinic and before discharge;
- determination of the total number of leukocytes and leukocyte formula.

 When using the proposed method of treatment, there is a positive dynamics in neurological symptoms in 70% of patients receiving lymphocytopheresis and treated autolymphocytes, while in patients receiving reaferon, this indicator was 55%. Moreover, the neurological dynamics on the J. Kurtzke scale was 1-2 points for 2-3 indicators (symptoms of a pyramidal pathway lesion, impaired coordination, impaired pelvic organ function, visual impairment) in the comparison group, while in the control group the improvement did not exceed 1 point and 1-2 indicators (symptoms of a pyramidal pathway lesion, impaired coordination). An immunological examination before and after lymphocytapheresis showed that there is an increase in total T-lymphocytes (LT-3) to normal values or to values close to the lower limit of the norm, and due to the inhibited link, T-suppressors (LT-8). Thus, it normalizes the immunoregulatory index. A decrease in the CEC is noted in cases where this indicator is increased.

 Clinical example. Patient 3.27 years. Diagnosis: Multiple sclerosis, cerebrospinal form, 3 tbsp. severity, progressive course, lower spastic paraparesis, cerebellar ataxia, bulbar syndrome.

 Sick for 9 years, when complaints about dizziness, double vision, weakness in the legs first appeared. These symptoms were short-term, stopped on their own. Since 1997, such symptoms have become more intense. Over the past year, the condition began to worsen progressively, weakness in the legs increased, double vision was maintained, he underwent treatment with dexamethasone with a temporary improvement.

 Upon admission to the patient according to the damage scale of functional systems according to J. Kurtzke, the total score was 14, after 3 courses of lymphocytopheresis, with the return of autolymphocytes treated with glutoxim, this indicator became equal to 9 points. There was an improvement of 2 points for pyramidal disorders and impaired coordination of 1 point for visual disturbances. In addition, the patient received vitamin therapy, laser therapy, drugs that improve the metabolism of the nervous tissue, nootropics according to the standard scheme. In the immunological picture, normalization of the content of total T-lymphocytes was noted due to an increase in previously reduced T-suppressors. Registered a decrease in the CEC after completion of treatment.

 At discharge, the patient's ability to work was restored.

 Using this method allows you to effectively influence pathologically altered immunological reactivity and thus change the course of the disease, which is reflected in the improvement of neurological symptoms and indicators of immune status.

Sources of information
1. Zavalishin I.A., Nevskaya O.M. Clinical criteria for the diagnosis and treatment of multiple sclerosis: guidelines // Moscow, - 1991.

 2. Zhuchenko TD, Zavalishin I.A. Treatment of multiple sclerosis // Neurological journal, M: Medicine, 1996. - 1. - P.37 - 43.

 3. Kurlzke J. F. Epidemiology of multiple sclerosis in US veterans; V. Ancestry and the risk of multiple sclerosis // Ann. Neurol., 1993 .-- 33. - P. 632-639.

 4. Fernandez 0., Antiquetful A., Aribisu T. et al. Treatment of relapsingremitting multiple sclerosis with natural interferon-beta: a multicenter, randomized clinical trial // Multiple Sclerosis, 1995.- 1 (Suppl.). - P. 67-69.

 5. Goodin D. S. The use of immunosupressive agents in the treatment of mul-tiple sclerosis // A critical review. Neurology, 1991 .-- 41. - P. 980-985.

Claims (1)

A method for the treatment of multiple sclerosis, characterized in that autolymphocytes in an amount of 400-1000 cells / ml are administered extracorporeally treated with an immunomodulator glutoxim at 24-26 ^{° C.} for 1 hour, the procedure is repeated three times with an interval of 48-72 hours.